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目的探讨老年不典型心肌梗死误诊的原因及对策。方法回顾性分析河南省新乡市第一人民医院近3年收治的老年不典型心肌梗死30例。结果本组30例病例中,无痛型患者17例,主要表现为呼吸困难、胸闷、气短、端坐呼吸、突然晕厥和头晕。异位疼痛型13例,表现为上腹痛、肩背痛、左上肢痛及咽部、下颌痛和牙痛等。结论老年心肌梗死不典型、临床医生对病史采集不详细,查体不严格及缺乏对老年不典型心肌梗死的认识,以及缺少对心电图的动态观察和必要的心肌肌钙蛋白的检测是误诊的主要原因。
Objective To investigate the causes and countermeasures of misdiagnosis of elderly atypical myocardial infarction. Methods A retrospective analysis of 30 cases of elderly atypical myocardial infarction admitted to the First People ’s Hospital of Xinxiang City, Henan Province in recent 3 years. Results The group of 30 cases, 17 cases of painless patients, mainly as dyspnea, chest tightness, shortness of breath, sitting and breathing, sudden syncope and dizziness. Ectopic pain in 13 cases, manifested as upper abdominal pain, shoulder pain, left upper limb pain and throat, jaw pain and toothache. Conclusion Aged patients with atypical myocardial infarction, clinicians did not collect the history of detail, check the body is not strict and lack of awareness of atypical myocardial infarction in elderly, and the lack of dynamic ECG and cardiac troponin detection is the main misdiagnosis the reason.